Rapidly Progressive Glomerulonephritis in an Otherwise Healthy Elderly Female




Vu, Michael


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Background: Rapidly progressive glomerulonephritis describes a clinical syndrome that is characterized by a rapid loss of renal function in a relatively short period of time, ranging from days to months, that can ultimately lead to complete renal failure. The histologic hallmark of RPGN presents as proliferating crescents found within the kidney glomeruli which are induced by inflammatory cytokines and made of fibrin, cellular components, and differentiating antibodies. RPGN can present as a wide variety of symptoms associated with severe acute kidney injury such as uremia, gross hematuria, edema, fatigue, hypertension, and oliguria. Case Information: A 73-year-old female with a past medical history of well-controlled hypertension, hyperlipidemia, and type 2 diabetes mellitus along with chronic kidney disease stage 3 and chronic heart failure with preserved ejection fraction (50-55%) presented after a ground level fall at home. Traumatic injury or loss of consciousness could not be ruled out. Reported symptoms included shortness of breath, oliguria, and generalized weakness. With extensive workup and evaluation, patient exhibited markedly elevated creatinine from baseline, elevated inflammatory markers, fractional sodium excretion indicative of intra-renal disease, crescent formation on renal biopsy, and blood work positive for cytoplasmic anti-neutrophil cytoplasmic and myeloperoxidase antibodies. Treatment was initiated with aggressive steroid therapy, therapeutic plasmapheresis, and immunosuppressant therapy with Rituximab. Conclusions: If left untreated, RPGN can be a severe syndrome that can lead to end-stage renal failure, subsequent infection, and/or massive pulmonary hemorrhage. Hallmark of treatment is centered around high-dose steroid therapy and immunosuppression. Expectations of said treatment are focused on decreasing the degree of irreversible renal injury rather than complete remission. Outcomes remain largely dependent of time of diagnosis or clinical suspicion. Even though clear diagnostic findings are outlined along with treatment guidelines, a large deal remains to be discovered regarding definitive pharmacologic options. Treatment plans should include extension discussion with the patient and family remembers regarding quality of life, side-effects and burden of aggressive immunosuppressive therapy, and degree of irreversible renal damage.


Research Appreciation Day Award Winner - 2019 Medical Student Government Association - Best in Third Year Class